ABSTRACT

To evaluate the clinic and surgical treatments of dermoid cysts, as benign choristomas in orbita.

Seventeen patients who had orbital dermoid cyst surgery between 2007-2011 were investigated retrospectively. Dermoid cysts that were located around the orbit were included. The ones that developed inside the orbit and on the conjunctiva were excluded. All patients were examined by the biomicroscope, for anterior segment and fundus inspection and also their orbital MR-CT images were obtained. Operations were performed under general or local anesthesia, according to the patients’ ages and personal choices. Incisions were performed on the eyebrow or upper eyelid sulcus to hide incision scars. Specimens were inspected pathologically. Oral amoxyicilline + clavulanic acid was ordered 1 g (2x1) for adults and 25/3.6 mg/kg/day for children; and oral antiinflamatory, naproxen 550mg was ordered twice a day for adults and ibuprofen 20mg/kg/day for children. Tobramisin eye-drops 5x1 and tobramycine cream only once before sleep was ordered for all patients postoperatively. Sutures were removed on the postoperative seventh day. Massage with tobramycine cream 3x5 minutes for 3 months was advised if the incision scar was significantly noticeable. Scars were graded according to patients‘ satisfaction. (very good-rewarding-poor) If very good or rewarding, the operation was considered successful. Mean follow-up time was 7.9 (6-12) months. All results were analysed according to the clinical and surgical methods performed.

Mean age was 23.4 years (2-63). 6 (34.3%) of patients were male, 11 (64.7%) were female. Incisions were performed in the sulcus in 5 patients, in the eyebrow in 12 to hide incision scars. Cysts were excised totally with the capsule in 15 cases. In 2 patients cysts were ruptured. For these cases, cyst were immobile and adhered to the cranial periosteum. Inflammation occured in these cases but no relapse was noted. No serious scar developed on incisions. Dermoid cysts were on the superior and temporal region of the orbit in 70.6% (12) of patients, on the superior and nasal region in 17.6% (3) and on the sulcus of the superior eye-lid in 11.8% (2). 11 (64.7%) of all patients were pediatric cases (under 16 years). Dermoid cyst size was less than 1x1cm in five cases, and larger in 12 patients. 14 of patients were very good or satisfied and 4 were rewarding, according to the satisfaction grading scale. These 4 patients‘ dermoid cysts were greater than 1x1 cm size (Image 1-4). None of the patients were disatisfied.

Orbital dermoid cysts may cause serios complications although these are rarely encountered. Most orbital dermoid cysts were in pediatric cases and developed on the superior and temporal region of the orbit. The main treatment is total excision of the cyst without rupture. Making the incision on the sulcus or the edge of eyebrow is ideal in order to hide the incision scar. (JAREM 2011; 1: 1-3)

Keywords: Dermoid cyst, choristoma, excision, orbital tumor, incision